Should health records be online?

The trend in healthcare now is to give patients greater control over their own data

When even Conservative Party MPs seem unable to agree among themselves about
plans for electronic medical records, it demonstrates the challenges involved in
delivering what is a key goal for the NHS.

Former Tory frontbencher David Davis last week came out in strong opposition
to the storing of personal health records in cloud-based services. The party has
floated the idea as a policy twice this year, once in a speech by David Cameron
in April and last month in a story based on anonymous quotes given to The
Times newspaper.

The Tory proposal would be to use services such as Google Health or Microsoft
HealthVault to keep personal health records online, rather than storing them on
a central, state-run database that Cameron often refers to erroneously as the
“NHS supercomputer”.

Davis hates the idea because he believes that Google has a bad privacy
record. “We are still a long way from being able to give personal data to any
company, let alone Google,” he said, while highlighting the “massive weaknesses”
in a central database as well.

The online concept comes from the US, where there is no state health system
and healthcare is fragmented. A record stored in the cloud could be accessed by
any clinician anywhere in the country quickly and easily with the patient’s
permission.

The offerings from Microsoft and Google were only launched in 2007 and they
sit alongside a number of packages from smaller vendors. Universal electronic
records are a key part of President Barack Obama’s health reform plan, though it
is still unclear what form they will take.

The trend in healthcare is towards giving patients greater access and control
over their own health information, according to Abdul Roudsari, head of health
informatics at City University.

“It means doctors cannot hide evidence from patients, as in the case of
Harold Shipman, and should lead to greater trust between patients and
clinicians,” he said.

The NHS “spine” system gives less control to patients than cloud-based
services, but still provides more control than has previously existed by
allowing patients to decide who can and cannot see their records.

But there are dangers in allowing patients greater access to their own
records. Some information could be detrimental to the health of the patient if
they see it at the wrong time or in the wrong way and could be open to
misinterpretation – which is even more likely with a cloud-based system that is
not overseen by health professionals.

And allowing patients to input their own health information unsupervised by a
clinician could produce inaccurate data.

A study by Stanford University published in 2006 found that proper education
– both online and offline – offers a solution.

“Reinforcement of the need to maintain the quality and accuracy of personal
health record information can occur as educational experiences unfold during the
primary and secondary school years,” says the report.

But both Google and Microsoft automatically import health data from a number
of sources so that when a patient has an operation, their record is updated
automatically by the health company, thus making inaccuracy less likely.

There are advantages to a cloud-based systems – alerts to upcoming
appointments, the rapid issue of test results, and reminders on treatment
programmes could all be more accessible to patients.

But such records are still less likely to be accurate and are more dispersed
than those held on a database, making them less useful for medical research –
one of the key aims of electronic health records.

However, the relative benefits of a cloud-based system could be a moot point
regardless of the Tory plans, according to one supplier involved with the NHS
National Programme.

“It is very unlikely that the Conservatives will ditch the spine system, so
cloud systems would only really be used to keep personal health information such
as diet and allergies up to date,” he said. “Why ditch the ready-made network we
already have?”

An NHS Direct web site called Healthspace already allows patients to do
exactly this – essentially serving the same purpose as the Google and Microsoft
systems and rendering them redundant, according to the supplier.

What they say about storing health records on Google:

Tory leader David Cameron: “People can store their health
records securely online, they can show them to whichever doctor they want.
They’re in control, not the state.”
Former Tory frontbencher David Davis: “What was proposed was both
dangerous in its own right, and hazardous to the public acceptability of
necessary reforms to the state’s handling of our private information.”
Peter Fleischer, Google’s global privacy counsel: “Mr Davis’s argument
is based on something of a straw man, given that Google Health, our health
records product, is only available in the US, and we have no immediate plans to
bring it to other countries.”

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